Processes of change in multisystemic therapy

Abstract

This thesis investigated processes of change in Multisystemic Therapy (MST) for adolescents with antisocial behaviour problems.
Part 1, the literature review, critically evaluates 28 studies investigating how neighbourhood effects on youth antisocial behaviour are mediated and moderated by family, peer and individual variables. The research demonstrated that neighbourhood risk influences young people's behaviour indirectly through more proximal processes such as parenting practices, peer deviancy and individual antisocial beliefs. Family risk was generally found to be amplified in disadvantaged neighbourhoods, such that parenting practices, especially monitoring, had a closer relationship to child behaviour in high-risk contexts, compared to in more advantaged neighbourhoods. Less interaction was found for individual risk factors such as low empathy, which tended to predict delinquency regardless of neighbourhood context
Part 2, the empirical paper, is a qualitative study of families' experiences of receiving Multisystemic Therapy, with a particular focus on processes of change. Semi-structured interviews were conducted with 22 parents and 19 young people, and accounts analysed with thematic analysis. Findings highlighted a wide range of positive changes in the young person's behaviour and attitude, as well as family relationships and parenting practices. Increased parenting confidence and competence, reduced conflict in the home, and a return to education for the young person were key to youth behaviour change. Accounts supported an ecosystemic model of intervention for youth antisocial behaviour.
Part 3, the critical appraisal, addresses methodological issues of the study. This includes consideration of the influence of researcher perspective, and the impact the research has had on the researcher's future clinical thinking and practice.